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A Statistical Model for Intervertebral Disc Degeneration: Determination of the Optimal T2 Cut-Off Values

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Summary

Purpose

The aim of this study was to investigate the possibility of quantitative classification in intervertebral disc degeneration using spin–spin relaxation time (T2) cut-off values with regard to morphological classifications.

Methods

Lumbar magnetic resonance (MR) imaging was performed on 21 subjects (a total of 104 lumbar disks). The T2 relaxation time was measured in the nucleus pulposus using a sagittal multi-echo spin-echo sequence. The morphological classification of disc degeneration was assessed independently by three experienced neuroradiologists according to the Pfirrmann and Schneiderman classifications. Receiver operating characteristic analysis was performed among grades to determine T2 cut-off values in each classification. Intra- and interobserver differences were calculated using kappa statistics.

Results

Moderate overall interobserver agreement was found between observers in both the Pfirrmann and Schneiderman classification schemes (kappa 0.46 and 0.51), while intraobserver reliability was substantial to almost perfect. The interobserver reliability was only fair in Pfirrmann grades III and IV (kappa 0.33 and 0.36), but the T2 cut-off values still indicated a significant difference between grades (p < 0.05).

Conclusions

Interobserver agreement of MR evaluation in patients with intervertebral disc degeneration was only fair to moderate on the classification of more severe disc degeneration in the Pfirrmann and Schneiderman schemes. Based on our results, quantitative T2 cut-off values seem to be a more reliable method to define the degree of disc degeneration, which may help staging intervertebral disc degeneration (IVDD) even if the interobserver reliability is low.

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Acknowledgment

The project was supported by research grants SROP-4.2.1.B-10/2/KONV-2010–0002, (Developing the South-Transdanubian Regional University Competitiveness), SROP-4.2.2/A- 11/1/KONV-2012–0017 and Hungarian Scientific Research Found OTKA-K109132. AS was supported by the Bolyai Scholarship of Hungarian Academy of Science. The local Diagnostic Center, Mihály Aradi M.D., Prof. József Janszky M.D., Ph.D., D.Sc. and Szilvia Erdélyi-Bótor M.D. are gratefully acknowledged for the MR imaging and technical advices.

Conflict of Interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Diagnostic Centre of Pécs, Rét Street 2, 7623, Pécs, Hungary

    S. A. Nagy, H. Komaromy, G. Perlaki, G. Orsi & P. Bogner MD, PhD

  2. Institute of Physical Education and Sport Sciences, Faculty of Sciences, University of Pécs, Ifjúság Street 6, 7624, Pécs, Hungary

    I. Juhasz

  3. Military Hospital Budapest, Róbert Károly BLVD 40–44, 1134, Budapest, Hungary

    K. Pozsar

  4. Semmelweis University MR Research Centre, Balassa Street 6, 1083, Budapest, Hungary

    I. Zsigmond

  5. MTA-PTE Clinical Neuroscience MR Research Group, Rét Street 2, 7623, Pécs, Hungary

    G. Perlaki, G. Orsi, A. Schwarcz & T. Doczi

  6. Department of Neurosurgery, University of Pécs, Rét Street 2, 7623, Pécs, Hungary

    A. Schwarcz, T. Doczi & P. Bogner MD, PhD

  7. Health Centre, Kaposvár University, Guba S. Street 40, 7400, Kaposvár, Hungary

    N. Walter

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  1. S. A. Nagy
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  2. I. Juhasz
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  3. H. Komaromy
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  5. I. Zsigmond
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  6. G. Perlaki
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  7. G. Orsi
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  9. N. Walter
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  10. T. Doczi
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  11. P. Bogner MD, PhD
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Correspondence to P. Bogner MD, PhD.

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The first two authors have contributed equally to this article.

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Nagy, S., Juhasz, I., Komaromy, H. et al. A Statistical Model for Intervertebral Disc Degeneration: Determination of the Optimal T2 Cut-Off Values. Clin Neuroradiol 24, 355–363 (2014). https://doi.org/10.1007/s00062-013-0266-2

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